生物制剂联合内镜下球囊扩张术预防克罗恩病肠道狭窄复发的疗效初探

Clinical efficacy of biologics combined with endoscopic balloon dilatation for the prevention of intestinal stenosis in Crohn disease

摘要:

目的 评价生物制剂联合内镜下球囊扩张术（endoscopic balloon dilation，EBD）预防克罗恩病肠道狭窄复发的效果，并探讨EBD术后肠道狭窄复发的高危因素。方法 2016年1月至2023年12月，就诊于常州市第一人民医院消化内科，行EBD联合或未联合生物制剂治疗的克罗恩病肠道狭窄病例纳入回顾性队列研究，分成联合组和未联合组，比较2组肠道狭窄实际复发率；同时，使用Kaplan‑Meier法对2组肠道狭窄无复发生存率进行估计，组间差异行log‑rank检验。并采用Cox比例风险回归模型对纳入研究病例的生存数据进行多因素分析，以探讨EBD术后克罗恩病肠道狭窄复发的独立危险因素。结果 按纳排标准最终有47例纳入研究，联合组29例、未联合组18例，2组基线资料具有可比性。联合组有6例（20.7%）复发，未联合组10例（55.6%）复发，联合组肠道狭窄实际复发率低于未联合组。Kaplan‑Meier生存曲线分析结果显示，联合组累积肠道狭窄无复发生存率明显高于未联合组（P=0.014）。Cox比例风险回归模型分析结果显示未联合生物制剂治疗的肠道狭窄复发风险明显高于联合生物制剂治疗（HR=5.360，95%CI：1.340~21.449，P=0.018），小肠部位的肠道狭窄复发风险明显高于非小肠部位（HR=7.746，95%CI：1.908~31.446，P=0.004）。结论 生物制剂联合EBD治疗克罗恩病肠道狭窄能有效预防肠道狭窄复发。对于克罗恩病小肠狭窄，建议联合生物制剂治疗以预防狭窄复发高发。

Abstract:

Objective To assess the effectiveness of the combined biological therapy and endoscopic balloon dilation (EBD) for preventing intestinal stricture recurrence in patients with Crohn disease, and to identify the risk factors for post-EBD stricture recurrence. Methods This retrospective cohort study enrolled Crohn disease patients who underwent EBD with or without biological therapy at the Department of Gastroenterology, the First People""s Hospital of Changzhou, from January 2016 to December 2023. The patients were divided into the biologics-EBD group and the EBD monotherapy group, and recurrence rates of intestinal stenosis between the groups were compared. The Kaplan-Meier method was employed to estimate the stricture-free survival, with intergroup differences assessed via log-rank test. The Cox proportional hazards regression model was utilized to perform a multivariate analysis of the survival data of the included cases for the independent risk factors for the recurrence of intestinal strictures after EBD in Crohn disease. Results In accordance with the inclusion and exclusion criteria, a total of 47 cases were ultimately included in the study, with 29 cases in the biologics-EBD group and 18 cases in the EBD monotherapy group. The baseline data of the two groups were comparable. Stricture recurrence occurred in 6/29 (20.7%) biologics-EBD patients versus 10/18 (55.6%) EBD monotherapy patients. Kaplan-Meier curves demonstrated superior cumulative stricture-free survival in the biologics-EBD cohort (P=0.014). Cox proportional hazards regression model confirmed elevated recurrence risk with EBD monotherapy (HR=5.360, 95%CI: 1.340‑21.449, P=0.018) and small intestinal strictures (HR=7.746, 95%CI: 1.908‑31.446, P=0.004). Conclusion The combination of biologics with EBD for the treatment of intestinal strictures in Crohn disease can effectively prevent the recurrence of intestinal strictures. Regarding small intestinal strictures in Crohn disease, it is suggested to combine biologics for treatment to prevent the high recurrence rate of strictures.